CBT can help you to change how you think (Cognitive) and what you do (Behaviour).
These changes can help you to feel better. Unlike some of the other talking treatments,
it focuses on the ‘here and now’ problems and difficulties. Instead of focusing on
the causes of your distress or symptoms in the past, it looks for ways to improve
your state of mind now.

It has been found to be helpful in:

Anxiety

Depression

Panic

Agoraphobia and other phobias

Social phobia

Bulimia

Obsessive Compulsive Disorder (OCD)

Post Traumatic Stress Disorder

Schizophrenia

How does it work?

CBT can help you to make sense of overwhelming problems by breaking them down into
smaller parts. This makes it easier to see how they are connected and how they affect
you. These parts are:

A Situation - a problem, event or difficult situation

From this can follow:

Thoughts

Emotions

Physical feelings

Actions

Each of these areas can affect the others. How you think about a problem can affect
how you feel physically and emotionally. It can also alter what you do about it.

An example

There are helpful and unhelpful ways of reacting to most situations, depending on
how you think about them:

The same situation has led to two very different results, depending on how you thought
about the situation. How you think has affected how you felt and what you did.

In the example in the left hand column, you've jumped to a conclusion without very
much evidence for it - and this matters, because it's led to:

A number of uncomfortable feelings

An unhelpful behaviour

If you go home feeling depressed, you'll probably brood on what has happened and
feel worse. If you get in touch with the other person, there's a good chance you'll
feel better about yourself. If you don't, you won't have the chance to correct any
misunderstandings about what they think of you - and you will probably feel worse.

This is a simplified way of looking at what happens. The whole sequence, and parts
of it, can also feedback like this:

Situation

Thoughts

Actions Feelings

This ‘vicious circle’ can make you feel worse. It can even create new situations
that make you feel worse. You can start to believe quite unrealistic (and unpleasant)
things about yourself. This happens because, when we are distressed, we are more
likely to jump to conclusions and to interpret things in extreme and unhelpful ways.

CBT can help you to break this vicious circle of altered thinking, feelings and behaviour.
When you see the parts of the sequence clearly, you can change them - and change
the way you feel. CBT aims to get you to a point where you can ‘do it yourself’,
and work out your own ways of tackling these problems.

‘Five areas’ Assessment

This is another way of connecting all the 5 areas mentioned above. It builds in our
relationships with other people and helps us to see how these can make us feel better
or worse. Other issues such as debt, job and housing difficulties are also important.
If you improve one area, you are likely to improve other parts of your life as well.

What does CBT involve?

The sessions

CBT can be done individually or with a group of people. It can also be done from
a self-help book or computer programme. In England and Wales two computer-based programmes
have been approved for use by the NHS. Fear Fighter is for people with phobias or
panic attacks, Beating the Blues is for people with mild to moderate depression.

If you have individual therapy:

You will usually meet with a therapist for between 5 and 20, weekly or fortnightly
sessions. Each session will last between 30 and 60 minutes

In the first 2-4 sessions, the therapist will check that you can use this sort of
treatment and you will check that you feel comfortable with it

The therapist will also ask you questions about your past life and background. Although
CBT concentrates on the here and now, at times you may need to talk about the past
to understand how it is affecting you now

You decide what you want to deal with in the short, medium and long term

You and the therapist will usually start by agreeing on what to discuss that day

The work

With the therapist, you break each problem down into its separate parts, as in the
example above. To help this process, your therapist may ask you to keep a diary.
This will help you to identify your individual patterns of thoughts, emotions, bodily
feelings and actions.

Together you will look at your thoughts, feelings and behaviours to work out:

If they are unrealistic or unhelpful

How they affect each other, and you

The therapist will then help you to work out how to change unhelpful thoughts and
behaviours .

It's easy to talk about doing something, much harder to actually do it. So, after
you have identified what you can change, your therapist will recommend ‘homework’
- you practice these changes in your everyday life. Depending on the situation, you
might start to question a self-critical or upsetting thought and replace it with
a positive (and more realistic) one that you have developed in CBT recognise that
you are about to do something that will make you feel worse and, instead, do something
more helpful.

At each meeting you discuss how you've got on since the last session. Your therapist
can help with suggestions if any of the tasks seem too hard or don't seem to be helping.

They will not ask you to do things you don't want to do - you decide the pace of
the treatment and what you will and won't try. The strength of CBT is that you can
continue to practise and develop your skills even after the sessions have finished.
This makes it less likely that your symptoms or problems will return.

How effective is CBT?

It is one of the most effective treatments for conditions where anxiety or depression
is the main problem

It is the most effective psychological treatment for moderate and severe depression

It is as effective as antidepressants for many types of depression

What other treatments are there and how do they compare?

CBT is used in many conditions, so it isn't possible to list them all. We will look
at alternatives to the most common problems - anxiety and depression.

CBT isn't for everyone and another type of talking treatment may work better for
you

CBT is as effective as antidepressants for many forms of depression. It may be slightly
more effective than antidepressants in treating anxiety

For severe depression, CBT should be used with antidepressant medication. When you
are very low you may find it hard to change the way you think until antidepressants
have started to make you feel better

Tranquillisers should not be used as a long term treatment for anxiety. CBT is a
better option

Problems with CBT

If you are feeling low and are having difficulty concentrating, it can be hard at
first,to get the hang of CBT or, indeed, any psychotherapy

This may make you feel disappointed or overwhelmed. A good therapist will pace your
sessions so you can cope with the work you are trying to do

It can sometimes be difficult to talk about feelings of depression, anxiety, shame
or anger

How long will the treatment last?

A course may be from 6 weeks to 6 months. It will depend on the type of problem and
how it is working for you. The availability of CBT varies between different areas
and there may be a waiting list for treatment.

What if the symptoms come back?

There is always a risk that the anxiety or depression will return. If they do, your
CBT skills should make it easier for you to control them. So, it is important to
keep practising your CBT skills, even after you are feeling better.

There is some research that suggests CBT may be better than antidepressants at preventing
depression coming back. If necessary, you can have a ‘refresher’ course.

So what impact would CBT have on my life?

Depression and anxiety are unpleasant. They can seriously affect your ability to
work and enjoy life. CBT can help you to control the symptoms. It is unlikely to
have a negative effect on your life, apart from the time you need to give up to do
it.

What will happen if I don't have CBT?

You could discuss alternatives with your doctor. You could also:

Read more about the treatment and its alternatives

If you want to "try before you buy", get hold of a self-help book or CD-Rom and see
if it makes sense to you

Wait to see if you get better anyway - you can always ask for CBT later if you change
your mind

Situation

You’ve had a bad day, feel fed up, so go out shopping. As you walk down the road,
someone you know walks by and, apparently, ignores you.

Unhelpful

Helpful

Thoughts

He/she ignored me - they don’t like me

He/she looks a bit wrapped up in themselves - I wonder if there’s something wrong?